Department of Medicine at Harbor, University of California at Los Angeles Medical Center, Torrance, California.
Departments of Surgery, University of California at Los Angeles, Los Angeles, California.
Departments of Medicine, University of California at Los Angeles, Los Angeles, California.
The treatment of chronic hepatitis C (HCV) in human immunodeficiency virus 1 (HIV) infected individuals has been historically marked by low sustained virologic response (SVR) rates in comparison to those without HIV infection, resulting in the Food and Drug Administration (FDA) labeling those coinfected as a "special population with an unmet medical need."
We systematically reviewed the treatment of chronic HCV infection in those infected with HIV. We propose that with the advent of direct-acting antiviral (DAA) agents, patients co-infected with HCV and HIV have similar SVR rates as HCV mono-infected persons and that DAAs address an unmet medical need in this population.
A review was performed using Medical Subject Heading (MeSH) terms within the PubMed, EMBASE, and Cochrane Library databases to search for studies dated between January 2004 and July 2017. Keywords used in the study included "hepatitis C," "HIV," "coinfection," and "direct-acting antiviral."
SVR rates for those with HCV and HIV coinfection treated with interferon-based therapies were substantially lower that SVR rates of HCV mono-infected individuals. The advent of DAA agents has resulted in similar SVR rates between mono-infected and co-infected individuals, with SVR greater than 93%. These medications have been demonstrated to have improved safety, efficacy, and tolerability in comparison to interferon-based regimens.
The designation of a "special population" for those with co-infection requires reconsideration. DAA therapies have resulted in similarly high rates of SVR for HCV infection in those with and without HIV infection. Despite these improvements, however, clinicians must be cognizant of negative predictors of SVR and barriers to treatment that may be more common in the coinfected population.